Mumps

Mumps

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands; therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect word that means lumps or bumps within the cheeks.

Description

Mumps is a very contagious infection that spreads easily in such highly populated areas as day care centers and schools. Although not as contagious as measles or chickenpox , mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.

Causes & symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread through sneezing , coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally become noticeable in 14–24 days. Initial symptoms include chills, headache , loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12–24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, he or she becomes immune to the disease, despite how mild or severe symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis ). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting , pain with bending or flexing the head, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

Mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 patients with mumps encephalitis dies from the complication.

About one-quarter of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea , and headache. Pain and swelling usually subside after 5–7 days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries, or oophoritis, as a complication of mumps, but this condition is far less painful than orchitis in boys.

As of late 2002, some researchers in Europe are studying the possibility that mumps increases a person's risk of developing inflammatory bowel disease (IBD) in later life. This hypothesis will require further research, as present findings are inconclusive.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child's temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child's mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a "pouty" appearance. With so many people vaccinated today, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine . A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

As of late 2002, researchers in London have reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps, and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination.

Treatment

Nutritional therapy

Nutritional therapy may alleviate pain and aid healing. A nutritionist or naturopath may recommend the following:

drinking lots of fluids to replace fluid loss

eating only such easy-to-digest foods as soups, broth or bland foods

taking multivitamin/mineral supplement to help boost the immune function

Homeopathy

A number of homeopathic remedies can be used in the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops ) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands. A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.

Herbal therapy

Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection. Other herbs taken internally, such as cleavers (Galium aparine ), calendula (Calendula officinalis ), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body's internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner. Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens ) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.

Acupressure

Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.

Allopathic treatment

When mumps occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoiding fruit juices and other acidic foods or beverages that can irritate the salivary glands is recommended, as is avoiding dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Expected results

When mumps is uncomplicated, the prognosis for full recovery is excellent. In rare cases, however, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella . MMR is a live vaccine administered in one dose between the ages of 12-15 months, 4-6 years, or 11-12 years. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible health care workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over age one who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage, but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone becoming pregnant for three months following vaccination.

Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The person should, however, be vaccinated if no symptoms result from exposure to mumps.

Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.

Because mumps vaccine is produced using eggs, individuals who develop hives , swelling of the mouth or throat, dizziness , or breathing difficulties after eating eggs should not receive the mumps vaccine.

Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.

The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an MMR vaccine at 15 months of age.

The mumps vaccine has been controversial in recent years because of concern that its use was linked to a rise in the rate of childhood autism . The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism. A second study in Finland showed that the vaccine is not associated with aseptic meningitis or encephalitis as well as autism. Since these studies were published, American primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

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Mumps

Gale Encyclopedia of Medicine, 3rd ed.
COPYRIGHT 2006 Thomson Gale

Mumps

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands, therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect, meaning lumps or bumps within the cheeks.

Description

Mumps is a very contagious infection that spreads easily in such highly populated areas as day care centers and schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.

Causes and symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread by sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally occur in 14-24 days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12-24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 1048F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, they become immune to the disease, despite how mild or severe their symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis ). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

The mumps infection can spread into the brain causing inflammation of the brain (encephalitis ). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 with mumps encephalitis dies from the complication.

About one-quarter of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis ) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after five to seven days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries, or oophoritis, as a complication of mumps, but this condition is far less painful than orchitis in boys.

As of late 2002, some researchers in Europe are studying the possibility that mumps increases a person's risk of developing inflammatory bowel disease (IBD) in later life. This hypothesis will require further research, as present findings are inconclusive.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child's temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child's mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a "pouty" appearance. With so many people vaccinated today, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

As of late 2002, researchers in London have reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps, and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination.

Treatment

When mumps does occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoid fruit juices and other acidic foods or beverages that can irritate the salivary glands. Avoid dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Alternative treatment

Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.

A number of homeopathic remedies can be used for the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands. A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.

Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection. Other herbs taken internally, such as cleavers (Galium aparine ), calendula (Calendula officinalis ), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body's internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner. Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens ) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.

Prognosis

When mumps is uncomplicated, prognosis is excellent. However, in rare cases, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella. MMR is a live vaccine administered in one dose between the ages of 12-15 months, 4-6 years, or 11-12 years. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible health care workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over age one who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage, but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone pregnancy for three months after vaccination.

Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The person should, however, be vaccinated if no symptoms result from the exposure to mumps.

Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.

Because mumps vaccine is produced using eggs, individuals who develop hives, swelling of the mouth or throat, dizziness, or breathing difficulties after eating eggs should not receive the mumps vaccine.

Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.

The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an the MMR vaccine at 15 months of age.

The mumps vaccine has been controversial in recent years because of concern that its use was linked to a rise in the rate of childhood autism. The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine and autism. A second study in Finland showed that the vaccine is not associated with aseptic meningitis or encephalitis as well as autism. Since these studies were published, American primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

KEY TERMS

Asymptomatic— Persons who carry a disease and may be capable of transmitting the disease but who do not exhibit symptoms of the disease are said to be asymptomatic.

Autism— A severe developmental disorder that usually begins before three years of age and affects a child's social as well as intellectual development. Some researchers theorized that immunization with the MMR vaccine was a risk factor for autism.

Encephalitis— Inflammation of the brain.

Epidemic parotitis— The medical name for mumps.

Immunoglobulin G (IgG)— A group of antibodies against certain viral infections that circulate in the bloodstream. One type of IgG is specific against the mumps paramyxovirus.

Meningitis— Inflammation of the membranes covering the brain and spinal cord.

Orchitis— Inflammation or swelling of the scrotal sac containing the testicles.

Paramyxovirus— A genus of viruses that includes the causative agent of mumps.

Citation styles

Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

The Chicago Manual of Style

American Psychological Association

Notes:

Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.

In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.

Mumps

Mumps

Definition

Mumps is a relatively mild short-term viral infection of the salivary glands that usually occurs during childhood.

Description

Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands; therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect, meaning lumps or bumps within the cheeks.

Demographics

Mumps is a very contagious infection that spreads easily in such highly populated environments as daycare centers and schools. Although not as contagious as measles or chickenpox , mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92 percent of all children had been exposed to mumps by the age of 15. In the pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, fewer than 3,000 cases of mumps were reported throughout the entire United States, the equivalent of about one case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. After that, state-enforced school entry requirements achieved student immunization rates of nearly 100 percent in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, that is, about one case for every 5 million people.

Causes and symptoms

The paramyxovirus that causes mumps is harbored in the saliva and is spread by sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally occur in 14 to 24 days. Initial symptoms include chills, headache , loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face (parotitis) generally occurs within 12 to 24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic
beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once individuals have contracted mumps, they become immune to the disease, despite how mild or severe their symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15 percent of cases, the covering of the brain and spinal cord becomes inflamed (meningitis ). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting , and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

The mumps infection can spread into the brain causing inflammation of the brain (encephalitis ). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about one person in 100 with mumps encephalitis dies from the complication.

About one-fourth of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea , and headache. Pain and swelling usually subside after five to seven days, although the testicles can remain tender for weeks.

Girls occasionally suffer an inflammation of the ovaries (oophoritis) as a complication of mumps, but this condition is far less painful than orchitis in boys.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy on the basis of the physical symptoms. The doctor will take the child's temperature, gently palpate (touch) the skin over the parotid glands, and look inside the child's mouth. If the child has mumps, the openings to the ducts inside the mouth will be slightly inflamed and have a "pouty" appearance. With so many people vaccinated as of the early 2000s, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene , the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

In late 2002, researchers in London reported the development of a bioassay for measuring mumps-specific IgG. This test would allow a doctor to check whether an individual patient is immune to mumps and allow researchers to measure the susceptibility of a local population to mumps in areas with low rates of vaccination .

Treatment

When mumps does occurs, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin (only for individuals over the age of 20), acetaminophen , or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Patients should void fruit juices and other acidic foods or beverages that can irritate the salivary glands. They should also avoid dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Prognosis

When mumps is uncomplicated, prognosis is excellent. However, in rare cases, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella . MMR is a live vaccine administered in one dose between the ages of 12 and 15 months, between four and six years of age, or 11 and 12 years of age. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible healthcare workers, especially those who work in hospitals, should be vaccinated. Because mumps is
still prevalent throughout the world, susceptible persons over the age of one year who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should not be vaccinated against mumps:

Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone pregnancy for three months after being vaccinated.

Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The persons should, however, be vaccinated if no symptoms result from the exposure to mumps.

Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.

Because mumps vaccine is produced using eggs, individuals who develop hives , swelling of the mouth or throat, dizziness , or breathing difficulties after eating eggs should not receive the mumps vaccine.

Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.

The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive an the MMR vaccine at 15 months of age.

Parental concerns

The mumps vaccine has been controversial in the early 2000s because of concern that its use was linked to an increased rate of childhood autism . The negative publicity given to the vaccine in the mass media led some parents to refuse to immunize their children with the MMR vaccine. One result has been an increase in the number of mumps outbreaks in several European countries, including Italy and the United Kingdom.

KEY TERMS

Asymptomatic—Persons who carry a disease and are usually capable of transmitting the disease but who do not exhibit symptoms of the disease are said to be asymptomatic.

Autism—A developmental disability that appears early in life, in which normal brain development is disrupted and social and communication skills are retarded, sometimes severely.

Encephalitis—Inflammation of the brain, usually caused by a virus. The inflammation may interfere with normal brain function and may cause seizures, sleepiness, confusion, personality changes, weakness in one or more parts of the body, and even coma.

Epidemic parotitis—The medical name for mumps.

Immunoglobulin G (IgG)—Immunoglobulin type gamma, the most common type found in the blood and tissue fluids.

Meningitis—An infection or inflammation of the membranes that cover the brain and spinal cord. It is usually caused by bacteria or a virus.

Orchitis—Inflammation of one or both testes, accompanied by swelling, pain, fever, and a sensation of heaviness in the affected area.

Paramyxovirus—A genus of viruses that includes the causative agent of mumps.

Parotitis—Inflammation and swelling of one or both of the parotid salivary glands.

In the fall of 2002, the New England Journal of Medicine published a major Danish study disproving the hypothesis of a connection between the MMR vaccine
and autism. A second study in Finland showed that the vaccine is also not associated with aseptic meningitis or encephalitis. Since these studies were published, U.S. primary care physicians have once again reminded parents of the importance of immunizing their children against mumps and other childhood diseases.

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Mumps

Encyclopedia of Public Health
COPYRIGHT 2002 The Gale Group Inc.

MUMPS

Figure 1

Mumps is an acute infectious disease caused by a paramyxovirus. Humans are the only known natural host. Mumps disease is usually mild, characterized by fever and swelling of one or both parotid salivary glands. The parotiditis usually develops an average of sixteen to eighteen days after direct contact, through the nose or mouth, with the saliva of an infected individual. In approximately 20 to 40 percent of cases, however, mumps disease occurs asymptomatically or with an uncharacteristic presentation.

Even though mumps is regarded as a fairly benign disease in the twenty-first century, in the prevaccine era mumps caused much morbidity and mortality in the United States. In 1967, mumps accounted for over one-third of encephalitis cases and one death occurred out of approximately 20,000 mumps cases. Mumps infection during pregnancy is not associated with birth defects, but infection during the first trimester is associated with a greater occurrence of fetal death. Other conditions caused by mumps include meningitis, orchitis, mastitis, pancreatitis, neuritis, arthritis, nephritis, thryroiditis, pericarditis, and deafness.

Mumps parotiditis occurs equally among males and females. Severe mumps disease, however, such as encephalitis, has been observed to occur more frequently among boys than girls. Other gender-specific manifestations are also influenced by age. After puberty, orchitis commonly occurs among males, though sterility rarely results. Among post-pubescent females, mastitis is a common manifestation.

Mumps infection can be confirmed by isolation of the virus from throat swabs, urine, or spinal fluid. Blood tests to detect antibodies to mumps virus can be used to differentiate between a current mumps infection and a previous infection. Skin testing is not reliable.

In countries without mumps vaccination, epidemics occur every two to five years, affecting most frequently those ages five to nine. Mumps disease exhibits seasonally with more cases occurring during the winter and spring. Historically, mumps outbreaks occur in situations where individuals are grouped together, such as military camps, prisons, boarding schools, and aboard ships. In community outbreaks, school-aged children are often infected first and then infect family members at home.

The mumps virus was first identified in 1934. By 1948 a killed virus vaccine was licensed, but it was later discontinued because it did not produce long-lasting immunity. The current mumps vaccine in the United States is a live, attenuated vaccine (the Jeryl-Lynn strain) licensed in December 1967. Since introduction of the Jeryl-Lynn mumps vaccine, the reported number of mumps cases in the United States has decreased dramatically, from over 150,000 in 1968 to 387 cases in 1999 (see Figure 1).

The availability of this vaccine, the use of the combination measles, mumps, and rubella (MMR) vaccine beginning in 1986, and the two-dose recommendation in 1989 of MMR has immunized many children who would have otherwise have developed mumps disease.

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mumps

The Columbia Encyclopedia, 6th ed.

Copyright The Columbia University Press

mumps (epidemic parotitis), acute contagious viral disease, manifesting itself chiefly in pain and swelling of the salivary glands, especially those at the angle of the jaw. Other symptoms are fever, a general feeling of illness, and pain on chewing or swallowing. Mumps most often affects children between the ages of 5 and 15, the incubation period being 14 to 21 days; the acute phase rarely lasts more than 3 days. The disease is usually more severe in adults, the most common complications being pain and swelling of the testes (in 20% of adult male patients) and swelling of the meninges that cover the brain and spinal cord (in about 30% of cases). Sterility resulting from involvement of the testes and fatalities from the meningoencephalitis occur in a small minority of male cases. Other possible complications include pancreatitis and involvement of the heart or thyroid. The ovaries are sometimes affected in females. Treatment consists mainly of bed rest, intake of fluids, and the administration of analgesics. A live virus vaccine has been developed that can be given to susceptible children at 15 months.

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Mumps

UXL Complete Health Resource
COPYRIGHT 2001 The Gale Group, Inc.

MUMPS

DEFINITION

Mumps is a relatively mild viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheeks. In some cases, the swelling may occur in only one cheek, or there may be no swelling at all. The word "mumps" comes from an old English word meaning lumps or bumps in the cheeks.

DESCRIPTION

Mumps is a very contagious (catching) infection. It spreads easily in densely populated areas, such as schools. At one time, mumps was very common in the United States. Prior to 1967, about 92 percent of all children had been exposed to mumps by the age of fifteen. Most children developed the disease between the ages of four and seven. Mumps epidemics reappeared in two- to five-year cycles. The greatest mumps epidemic in modern times occurred in 1941. There were about 250 cases of the disease for every 100,000 Americans.

This pattern began to change in 1968, when a mumps vaccine was released. The vaccine proved very effective in preventing the disease. By 1985, less than 3,000 cases of mumps were reported in the entire United States. That works out to less than 1 case per 100,000 people.

Mumps: Words to Know

Encephalitis:

Inflammation of the brain.

Meningitis:

Inflammation of the tissue surrounding the brain and spinal cord.

Only two years later, the news about mumps in the United States had taken a turn for the worse. The rate of infections had increased five times. The reason given for this increase was the failure to have all young children vaccinated against the disease. Many states became concerned about this trend. They passed laws requiring all children in kindergarten and first grade to have vaccinations against mumps. The success of these efforts became apparent in 1996. In that year, only 751 cases of mumps were reported nationwide, or about 1 case for every 5 million people.

CAUSES

The virus that causes mumps lives in a person's saliva. It is spread by coughing, sneezing, or other direct contact between people.

SYMPTOMS

Once a person is exposed to the virus, symptoms occur in fourteen to twenty-four days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. Less than twenty-four hours later, the salivary glands in the face begin to swell. The patient finds it painful to chew or swallow, especially acidic beverages like orange juice and lemonade. A fever as high as 104°F is also common.

The swelling reaches a maximum on about the second day. It usually disappears completely by the seventh day. Once a person has had mumps, he or she can never have the disease again.

The majority of cases of mumps disappear without complications. Complications are more likely to occur with adults who get the infection. In 15 percent of all cases, the mumps virus spreads to the brain. There, it causes an inflammation of brain tissue known as meningitis (pronounced meh-nen-JI-tiss; see meningitis entry). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, and a lack of energy. Meningitis is a very serious condition and must be treated very quickly.

The mumps virus can cause another disease of the brain known as encephalitis ("brain fever"; see encephalitis entry). The symptoms of mumps encephalitis include the inability to feel pain, seizures, and a high fever. Most patients recover from mumps encephalitis without complications. In about 1 percent of all cases, a person dies from mumps encephalitis. Those who survive may develop seizure disorders that can stay with a person throughout his or her life.

About a quarter of all adolescent boys who develop mumps also experience swelling of the scrotum (the sac that contains the testicles). This swelling is accompanied by severe pain, fever, nausea, and headache. These symptoms tend to disappear after five to seven days, although the testicles may remain tender for weeks.

DIAGNOSIS

Before the mumps vaccine was developed, diagnosing mumps was easy. Most doctors had seen many cases of mumps and recognized the characteristic swollen salivary glands as a sign of the disease. Today, the disease is so rare that it can easily be missed. A doctor may attribute the swelling to some other condition, such as a bacterial infection. To diagnose mumps, then, the doctor's primary goal is to rule out other possible explanations for swollen salivary glands. A simple test is available that tells whether the swelling is caused by mumps or by some other condition, such as poor oral (tooth-care) hygiene.

TREATMENT

There is no treatment for mumps. All that can be done is to allow the disease to run its course. However, steps can be taken to make the patient more comfortable. For example, acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn,

trade name Tylenol), or ibuprofen (pronounced i-byoo-PRO-fuhn, trade name Advil) can help relieve the pain due to swelling, headache, and fever. Aspirin should never be given to children who have mumps. Aspirin has been found to cause Reye's syndrome (see Reye's syndrome entry), a potentially fatal disease.

Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated (given liquids). He or she should be provided with a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Fruit juices should be avoided because they can irritate the salivary glands. Patients also should not be given dairy products because they may be difficult to digest.

In the event of complications, a doctor should be contacted at once. For example, there are treatments that can relieve the discomfort of swelling of the scrotum.

Alternative Treatment

Some patients find that acupressure (a Chinese therapy that involves applying pressure to certain points in the body) can help relieve the pain of swollen glands. They use their middle fingers to press gently on the area between the jawbone and the ear for two minutes while breathing deeply.

GROWING VIRUSES

Until the 1940s, research on viruses progressed very slowly. A major problem was that no one knew how to grow viruses in the laboratory. By contrast, bacteria were easy to grow. Sometimes, all that was needed was to keep food open to the air. Bacteria grew quickly on the food.

An important breakthrough came when scientists discovered that viruses will grow in live chick embryos. Live chick embryos are easy to find—just crack open a fertilized egg! The problem was that bacteria also like to grow in chick embryos. By the 1940s, that problem could be solved as well. Simply adding an antibiotic to the chick embryo killed the bacteria, but had no effect on the viruses.

Much of the work done on growing viruses was conducted by American bacteriologist John F. Enders (1897–1985) and his colleagues at Children's Hospital in Boston. With the technique they developed, Enders and his colleagues were able to grow the viruses that cause mumps, measles, poliomyelitis, chickenpox, and other diseases. They eventually developed vaccines for mumps and measles. Other researchers later used the same techniques to develop a vaccine for poliomyelitis.

A number of homeopathic remedies have been recommended for various symptoms of mumps. These include belladonna for swelling and redness; wild hops for lack of energy, irritability, and thirst; and poke root for swollen glands. Homeopathic remedies that do not have an effect on the patient should not be continued.

Several herbal remedies may be useful in helping the body recover from a mumps infection or helping to relieve the discomfort of the disease. These herbs include echinacea (pronounced ek-i-NAY-see-uh), cleavers, calendula (pronounced KUH-len-juh-luh), and poke root. Poke root can be toxic, so it should be used only under the close supervision of a trained practitioner.

Some herbal remedies are applied as packs placed directly on the swollen glands. These packs may be dipped in a solution of vinegar and cayenne or a solution made from cleavers or calendula mixed with vinegar and heated.

PROGNOSIS

The prognosis for mumps is usually excellent. Most patients recover completely from the disease with no aftereffects. In rare cases, a relapse (return of the disease) may occur after about two weeks. Complications occur rarely.

PREVENTION

Today, mumps is a preventable disease. A vaccine against the disease is usually given in combination with vaccines for measles (see measles entry) and rubella (see rubella entry). The vaccine is called the MMR vaccine. It is usually given in a single dose between the ages of twelve and fifteen months, four and six years, or eleven and twelve years. Anyone who is not certain whether he or she has had a vaccination should be vaccinated.

Vaccinations are also recommended for certain groups of people. For example, health-care workers should be vaccinated to protect them from infection by clients. People who travel to other parts of the world should consider a mumps vaccination. Although the disease has largely disappeared in the United States, it is still common in many other parts of the world.

On the other hand, there are some people who should not be vaccinated against mumps. For these people, the vaccine can be more dangerous than the disease it is intended to prevent. Among those who should not be vaccinated are the following:

pregnant women

anyone with an illness accompanied by a mild fever

people who are allergic to eggs and/or egg products

persons with conditions that have damaged their immune systems, such as those who are HIV-positive

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Mumps is an infection caused by a virus. The mumps virus can infect various parts of the human body but typically attacks the salivary glands. The mouth has three pairs of salivary glands: one pair under the mouth and lower jaw; a second pair under the tongue; and a third pair in the back of both cheeks between the ear and the jaw. In most cases, mumps affects the third pair, called the parotid glands*, causing them to swell painfully.

(puh-RAH-tid) gland is the salivary gland located in the jaw just beneath and in front of each ear.

In some patients, the virus spreads to the central nervous system* and causes a condition called aseptic meningitis*. Up to 15 percent of patients who have mumps, most commonly adults, will develop cases of meningitis with symptoms (such as headache and stiff neck).

(a-SEP-tik meh-nin-JY-tis) is a milder, non-bacterial form of meningitis that is usually caused by a virus. Meningitis is an inflammation of the meninges, or the membranes that surround the brain and the spinal cord.

Before the introduction of the mumps vaccine in 1967, the infection was also a major cause of acquired (not present at birth) deafness in childhood. Deafness occurs in about 1 out of 20,000 cases of mumps, often in only one ear.

Mumps was a common childhood illness in the United States until 1967, when a vaccine was made available to the public. Before the vaccine, most mumps infections occurred in children under the age of 15, and 5- to 9-year-olds were the most frequently affected age group. In the twenty-first century, many cases are diagnosed in young adults who have not been immunized.

Since 1967, cases of mumps have declined steadily. Statistics indicate the dramatic impact that the vaccine has had. In 1964, approximately 212,000 cases of mumps were diagnosed in the United States. By 2001, that number had dropped to 231 cases, according to the U.S. Centers for Disease Control and Prevention.

Epidemics* of mumps are rare and usually break out among people who have not been vaccinated and who live in close quarters, such as

(eh-pih-DEH-miks) are outbreaks of diseases, especially infectious diseases, in which the number of cases suddenly becomes far greater than usual. Usually, epidemics that involve worldwide outbreaks are called pandemics.

army camps and college dormitories. For example, a small outbreak of the disease occurred between 1986 and 1987, mostly in older children and college-age students, because of insufficient immunization during a period from 1967 to 1977.

Although swollen salivary glands are typically associated with mumps, approximately one-fifth of people infected with the virus show no symptoms. Photo Researchers, Inc.

Mumps is highly contagious. People infected with the mumps virus can spread it when they laugh, cough, or sneeze. Direct contact with saliva or fluid from an infected person’s nose also can spread mumps. Patients are contagious from about 1 day before their glands become swollen to up to 3 days after the swelling has improved.

Signs and symptoms

About 1 in 5 people who develop mumps have no symptoms. Many patients who do show signs of infection have only general symptoms such as a low fever, extreme tiredness, loss of appetite, muscle pain, and headache. Symptoms usually appear within 14 to 25 days after exposure to the virus.

Only 30 to 40 percent of people who become infected with the mumps virus have the swelling in the jaw area that most people associate with mumps. Earache and tenderness in the jaw are often the first signs of inflamed parotid glands. In 2 out of 3 cases of mumps, both parotid glands become swollen and painful, with one side swelling a few days before the other. Some patients also experience swelling in the other salivary glands. Talking, chewing, and swallowing can be painful, especially if the person eats or drinks acidic or sour food and beverages (such as lemonade and orange juice), which make the salivary glands squeeze out more saliva and increase discomfort.

Diagnosis and treatment

A doctor typically diagnoses mumps by examining a person who has symptoms of the infection. Other infections can cause swelling in the salivary glands, too, so a doctor may take a sample of blood to look for antibodies* to the virus. Other tests that can be used to diagnose mumps include culturing* samples of saliva or urine to find the mumps virus.

(KUL-chur-ing) means being subjected to a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.

Most cases of mumps can be treated at home. Over-the-counter pain medication, such as acetaminophen (uh-see-teh-MIH-noh-fen), can ease pain and fever, and warm or cold packs can soothe the pain of swollen, inflamed parotid glands. Resting and drinking plenty of non-acidic fluids help the body recover. The symptoms of mumps begin to clear up after 1 week and are usually gone within 10 days.

Complications

Complications of mumps are rare but can be serious and may require additional treatment under a doctor’s care or even hospitalization. The infection can lead to inflammation and swelling of the brain (encephalitis, en-seh-fuh-LYE-tis), as well as inflammation of the pancreas* (pancreatitis, pan-kree-uh-TIE-tis), other organs, or the membranes covering the brain and the spinal cord (meningitis). If symptoms of encephalitis or meningitis occur, it usually is within 3 to 7 days after the swelling of the parotid glands begins. These symptoms include high fever, stiff neck, and headache. In some patients with mumps, an electrocardiogram* (EKG) will show signs of myocarditis*, but the condition rarely is severe enough to produce symptoms with mumps.

(my-oh-kar-DYE-tis) is an inflammation of the muscular walls of the heart.

Up to half of all males who become infected with the mumps virus after puberty experience painful swelling of the testicles* as a complication of the disease. Usually one testicle becomes swollen, but in some cases both do. High fever, chills, headache, nausea (NAW-zee-uh), and vomiting accompany the swelling, which generally goes away within a week after it appears, along with the fever and other symptoms. In rare cases, this swelling can permanently damage the testicle leading to infertility* because of reduced ability to produce sperm cells. Only 5 percent of females who contract mumps after puberty will develop inflammation of the ovaries*, which causes abdominal* pain and other symptoms similar to those of appendicitis*.

Immunization is the best way to prevent mumps, and the vaccine usually is administered during early childhood. The vaccine requires two doses and generally is given in the same shot with the vaccines for measles and rubella. It is known as the MMR (measles-mumps-rubella) vaccine. The first dose typically is given when an infant is between 12 and 15 months old and the second when the child is between 4 and 5 years old. Avoiding close contact with someone who has been diagnosed with mumps also reduces the risk of contracting the virus, particularly if the uninfected person has not been vaccinated.

Organizations

U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894. The National Library of Medicine has a website packed with information on diseases such as mumps, consumer resources, dictionaries and encyclopedias of medical terms, and directories of doctors and helpful organizations.

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including mumps.

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mumps

mumps (mumps) n. a common virus infection mainly affecting children. Symptoms appear 2–3 weeks after exposure: fever, headache, and vomiting may precede a typical swelling of the parotid salivary glands. The infection may spread to other salivary glands and to the pancreas, brain, and testicles (see orchitis). See also MMR vaccine. Medical name: infectious parotitis.

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mumps

mumps Viral disease, most common in children, characterized by fever, pain and swelling of one or both parotid salivary glands (located just in front of the ears). The symptoms are more serious in adults, and in men inflammation of the testes (orchitis) may occur, with the risk of sterility. Vaccination produces life-long immunity.

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Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

The Chicago Manual of Style

American Psychological Association

Notes:

Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.

In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.